Monday, October 29, 2012

Now I am old enough to have taken the PSAT and SAT in the 50s. Yes, that long ago. I went to a classics oriented secondary school where the emphasis was on Latin, Middle English, Solid Geometry, etc and less on what was becoming contemporary requirements in the public arena. So one day in early Junior year we all got called into to take what was the PSAT. Frankly I had no idea what it was and just punted, after all I was in the midst of Cicero and who really cared about wasting a morning on a test. Needless to say I did not do well and it was not until the results came in that I realized that these tests had some importance.

Now as a student of a good Catholic school I knew that my best chances were to ask my friends at the local Jewish Community Center what to do. The CYO just played basketball and that would not be a viable career option. So off to the intersection of Forest Avenue and Victory Blvd and seeking wisdom, the answer was the Bronstein and Wiener course at the Commodore Hotel in NY (now the Hyatt) on Saturday mornings. So I took my lifeguard funds, signed up and every Saturday, for what I believe was ten weeks, I went amidst this crowd of intent exam passers and along with the exam review book, of which I did every problem and memorized every word, I then was prepared for the December SAT.

Now there is also a technique for taking the SAT. It was at Curtis HS near Port Richmond. I was primed. I arrived dressed casually, as one did in the 50s, and just sat with no evidence of last minute preps. I did not even have a pencil! I looked around saw some acquaintances and just asked what they thought of the dance last evening. Dance!

They all were studying! What I wondered. I had a secret, I prepped with the most aggressive mental animals in New York City for months, my group would make the products of Tiger Moms look like wimps, my group was the descendants of Feynman, Rockaway Beach, Stuyvesant, Bronx Science, Brooklyn Tech, mad intellectual animals, all seeking MIT admission, no one ever thought of wasting time at Harvard and Princeton was after all in New Jersey and Yale could never be found amidst the mess there in New Haven. Besides MIT was a factory, we all understood factories.

The next trick is to finish with more than half the time left. I accomplished that task easily, then stride outside and wait on the corner until the others come out. The look on the faces of the exam takers as you walk up less than half way trough looking totally at ease and hand in your exam. It terrifies the rest, and I would guess drop their scores at least 100 points!

Now for the results. Not only perfect but I found mistakes, yes my readers the SAT had errors. Not only had they told me that prep was useless and that was totally wrong but they had made mistakes. I wrote then but all I received was a form letter informing me of the fact that others had also informed them. Were they sorry? No, after all they are the SAT!

Now to why this rant if you will. In the NY Times there is a brief discussion regarding SATs and prep. It states:Q: Several readers have found incredible your assertions that test-prep activities and tutoring have only minimal impact
on students’ scores. Are you truly suggesting that such resources are
not beneficial enough to pursue? Why do you offer test-prep materials on
your Web sites, and what is your response to tutors who write that
their test-prep techniques have been successful?...

Ms. Juric: While the idea that test-prep activities do
not materially improve SAT scores may seem counterintuitive, several
highly respected independent organizations — including the National Association for College Admission Counseling (Nacac) — have conducted research showing that to be the case.

My response, Balderdash! Those kids with me at Bronstein and Wiener in the Commodore, they showed up at MIT. Personally I just about doubled my score from the PSAT, adjusting for baseline. If you do not know the vocabulary then you will not do well, if you have not read extensively, you will not do well, if you have not drilled the math style, you will not do well.

The answer was evasive at best, use someone else to cover for you perhaps. Counter-intuitive, to say the least. What is clear is that a personal commitment to excel is essential. But it is like studying for the Medical Boards or the Bar, you just have to consume many facts but at the same time you must not have to spend time understanding the question, it should be clear from prior practice.

Sunday, October 28, 2012

In the early 1950s, when I lived on Staten Island, I remember the hurricanes that hit New York, especially Staten Island. The areas down by the beaches were well under water, today there must be billions of dollars of homes and major hospitals. I wonder how they will fare.

This will be an interesting exercise in human response. We have buttoned down everything, have batteries, water, secured the outdoors, generator, sump pumps, back up sump pumps, hand pumps etc. Prior planning prevent poor performance, perhaps.

It will be undoubtedly a total loss in power for days, that after all is how the power company operates, they get paid only after a disaster and at premium prices. It seems that our Government officials really do not give a shilling. But alas the following week is election week, we shall see the effect.

One good thing, it hopefully keeps the teenage monsters from our door on Halloween. God acts in strange ways. Or be careful what you pray for!

Wednesday, October 24, 2012

NEJM just released a poll regarding the continuing use of PSA tests. They state:

We received 958 votes from readers in 67 countries. A little over half
(55%) of all voters recommended PSA screening for the man in our
clinical vignette — a split that revealed the lack of clinical consensus
surrounding this important issue. North American voters preferred to
screen with PSA testing: 59% of 489 voters from the United States and
67% of 46 Canadians voted in favor of PSA screening. European voters
were less enthusiastic, with only 47% of 217 voters in favor of PSA
screening.

They continued:

A large number of respondents remarked that they recommended PSA
screening on the basis of personal experience with elevated PSA levels
that led to life saving treatment. Other respondents believed that data
from the European Randomized Study of Screening for Prostate Cancer
provide compelling evidence that PSA screening saves lives. Finally, a
number of comments touched on patients' fears with regard to cancer
diagnosis, and some clinicians were of the opinion that measuring the
PSA level can reassure a patient that his physician is actively
performing surveillance.

But as we had noted before the European Trial did PSA tests with 4 year intervals. As we have argued before the 4 year interval is the equivalent of not even testing. Thus it can be argued that the European tests are invalid in terms of their conclusions.

Tuesday, October 23, 2012

The US Navy has had and continues to have a unique role in
US international presence. On the one hand it has the function of protecting
the ocean borders of the United States, apart from the policing actions of the
Coast Guard. Second, it has the duty to ensure that US interests are protected
abroad, from threats, from attacks, and the like. For example if an enemy fleet
of whatever type were to attempt to breach the borders of the United States by
sea then the Navy has the duty to protect those borders. Also if U.S. ships,
persons, or even business were under threat on foreign seas or lands then the
Navy has the prime duty to send defense to protect those interests. That is
assuming they are allowed to.

Thus two decades ago the 6th Fleet roamed the Med
and if a Libyan attack had occurred then the fleet could launch jet attack
aircraft in minutes and helicopter relief ships in less than two hours. Now we
have most likely a few tugs in the Med, thus the Libyan disaster. Naples is at
best a port of repair, and the Med is open to all comers.

The Admirals of the type of King, Nimitz, and Spruance seem
no longer to exist, those there are politically tuned and thus avoid conflict
and in my opinion confuse the mission.

Let us examine the current fleet. There are 287 Deployable Battle Force Ships. Amongst that there
are only six Aircraft Carriers composed of the following: [1]

USS Enterprise (CVN 65) - 6th Fleet

USS Nimitz (CVN 68) - Pacific Ocean

USS Dwight D. Eisenhower (CVN 69) - 5th Fleet

USS George Washington (CVN 73) - South China Sea

USS John C. Stennis (CVN 74) - 5th Fleet

USS Harry S. Truman (CVN 75) - Atlantic Ocean

Also there are only 6 Amphibious Assault Ships comprised of
the following:

USS Peleliu (LHA 5) - port visit Phuket, TH

USS Wasp (LHD 1) - Atlantic Ocean

USS Bataan (LHD 5) - Atlantic Ocean

USS Bonhomme Richard (LHD 6) - port visit Sepangar, MY

USS Iwo Jima (LHD 7) - 5th Fleet

USS Makin Island (LHD 8) - Atlantic Ocean

The typical Carrier Group is composed of 6-10 ships:

1.1 Carrier: The carrier
provides a wide range of options to the U.S. government from simply showing the
flag to attacks on airborne, afloat and ashore targets. Because carriers
operate in international waters, its aircraft do not need to secure landing
rights on foreign soil. These ships also engage in sustained operations in
support of other forces.

Now a ship is at sea for 4 months at a time. That means that
despite the fact that we have 6 Carrier groups we have only 2 at any one time
deployed under full condition. Thus given the current strength of the Navy we
have a truly weak presence. Thus, there most likely no way to react to Libya.

What should a naval strategy be? That is an oft debated
question. Do we still need a stealthy nuclear attack fleet? Would we use it and
against whom. Should the littoral fleet be expanded? Are we concerned about in
close warfare, and how complex should the littoral fleet be? One of the typical
Naval and DOD problems is that they take a simple ship concept such as the
littoral craft and turn it into a multi-billion dollar affair. Why not keep
them at say the old Fletcher class destroyers, sleek, light, and mobile. That
is a swarming attack and defense force. I have written extensively about this
in the past and rapid deployment and mobility at low costs are essential.

Reconnaissance can now be accomplished by various means and
methods from drones to the NRO fleet of satellites. C3I should be
well developed. The Navy should have an expansive mission with plans for
flexible roles in many theatres. China has one rebuilt nuclear carrier, not
that they cannot build a half dozen, but deploying them would take time. Russia
has reduced its presence. The nature of the enemy has changed. It is pirates in
the Indian, and frankly concerns about the shores of the homeland.

Thus frankly the dismissive comments by the current
president are not only to be concerned about but frankly they should be
terrifying. One should remember that on 9-11 we had only 2 unarmed
Massachusetts National Guard jets available for New York City. There were more Czech jest available for Prague! The prior administration had
gutted national defense assuming a new century of peace and when it comes to protecting ourselves we had not
one bullet.

Now the threat is magnitudes higher and the planning and
execution must meet the challenge. We need Admirals who can articulate a plan, reasons for why they need what. We must not retreat into the slumber of the 1930s, with not even the fuels to set the few ships asail.

In a recent paper by Siddiqui and Rajkumar the authors
detail the costs of some of the recent cancer drugs[1].
They state:

Last year, ipilimumab (Yervoy; Bristol-Myers Squibb, New
York, NY) was approved by the Food and Drug Administration (FDA) for the treatment
of metastatic melanoma. The benefit in survival over and above standard
treatment arms was 3.7 months in previously treated patients and 2.1 months in
previously untreated patients.The
cost: $120,000 for 4 doses. As staggering a figure as that is, the drug is
hardly alone in its lofty price. We believe that the immense cost of
contemporary cancer drugs signals even greater costs for future drugs.

The following Table is from their paper as modified. Note
the annual costs. What are not presented are the survival rates, for example
melanoma extends survival 4 months for $120,000. That is $30,000 per month.

Generic drug name

Cancer

Cumulative drug cost for
1 y ($)

Ipilimumab

Melanoma

120,000

Sipuleucel-T

Prostate cancer

90,000 for 3 doses

Bevacizumab

Various cancers, including lung
and colon cancer

90,000

Paclitaxel, protein-bound

Breast cancer

80,000

Lenalidomide

Multiple myeloma

90,000

Bortezomib

Multiple myeloma

60,000

Imatinib mesylate

Chronic myeloid leukemia

70,000

Alemtuzumab

Chronic leukemias

70,000

Ofatumumab

Lymphomas and chronic lymphoid
leukemias

120,000

Brentuximab vedotin

Hodgkin lymphoma

100,000

Dasatinib

Chronic myeloid leukemia

110,000

Now the authors proceed to argue why they are so expensive
and argue as to what can be done to reduce costs. In a sense this is still
health care research financed by the public and not really beneficial drug
disbursement. Almost all of these drugs are at best minimal life prolongers.
Perhaps we are at a very early stage where we use large populations to fund
experimental protocols as well as drugs.

Monday, October 22, 2012

We have heard a great deal about what caused the collapse of housing and the exploding US Debt. There have been many reasons for it but perhaps there is one which may truly have been at its heart, a tax policy.

In 2007 Congress passed and the President signed a change to the Tax Code, calledThe Mortgage Forgiveness Debt Relief Act and Debt Cancellation. Before this if you lost your house in a bad deal and the bank wrote off he mortgage you were on the hook for taxes on the loss. Short sales had the same effect. Namely the individual had an incentive to not take a lass, there was a dire penalty at the end.

As the IRS says:

If you owe a debt to someone else and they cancel or forgive that debt, the canceled amount may be taxable.

The Mortgage Debt Relief Act of 2007 generally allows taxpayers to
exclude income from the discharge of debt on their principal residence.
Debt reduced through mortgage restructuring, as well as mortgage debt
forgiven in connection with a foreclosure, qualifies for the relief.

This provision applies to debt forgiven in calendar years 2007 through
2012. Up to $2 million of forgiven debt is eligible for this exclusion
($1 million if married filing separately). The exclusion does not apply
if the discharge is due to services performed for the lender or any
other reason not directly related to a decline in the home’s value or
the taxpayer’s financial condition....If you borrow money from a commercial lender and the lender
later cancels or forgives the debt, you may have to include the
cancelled amount in income for tax purposes, depending on the
circumstances. When you borrowed the money you were not required to
include the loan proceeds in income because you had an obligation to
repay the lender. When that obligation is subsequently forgiven, the
amount you received as loan proceeds is normally reportable as income
because you no longer have an obligation to repay the lender.

Namely you had strong disincentives prior to this but now you can just walk away with no penalty. That meant that the downside risk was zero. That meant that many people just walked, took no responsibility and let the house drag down everything

There is talk that this may be revised and renewed. I believe that such a down side risk would actually stabilize the market.

Sunday, October 21, 2012

The former White House CEA head, Ms Romer, has written an amazing piece in today's NY Times. She states:

After listening to Representative Paul Ryan in the vice-presidential debate,
you might think that careful evaluation isn’t needed. In his view, we
spent $800 billion on the stimulus, yet unemployment still rose to 10
percent — so obviously it wasn’t helpful.

To understand what’s wrong with that reasoning, think of someone who’s
been in a terrible accident and has massive internal bleeding. After
lifesaving surgery, the patient still feels rotten. But we shouldn’t
conclude from this lingering pain that the surgery was useless — because
without it, the patient would have died...

The ultimate verdict on the Recovery Act will depend in part on further
studies. I believe that as more research occurs and the political rancor
fades, the fiscal stimulus will be viewed as an important step at a
bleak moment in our history. Not the knockout punch the administration
had hoped for, but a valuable effort that improved the lives of many.

There is no ultimate verdict. Month by month, since she put out her paper, I have tracked and reported on her grossly inaccurate predictions. Fact! She has never even been close in her predictions.

The surgical analogy is absurd! In this case she promised specific improvement, by the month and by the numbers. Never Happened!

If a surgeon performed an operation and charged you a fortune and promised certain levels of specific improvement and it did not happen, welcome to a lawsuit! But in her case it just needs further study. I have been viewing the fiscal stimulus in the light of what she and her colleague said would happen, I did not make up the numbers, she did. How can one have the gall to write this?

No wonder with people like this we are in such a mess, and we keep educating more of them, or perhaps we should call it indoctrination.

Saturday, October 20, 2012

I had commented on the Google acquisition of Motorola Mobile as at best problematic and at worst a very bad decision. Google is really in the service business. Namely people get a service from Google, search or ads, and they do not have to assemble it, it comes prepackaged. There is no inventory needed and the infrastructure is generally unseen.

The product business is quite different. Motorola Mobile is in the product business, it makes things, and the customer really does assemble them, and you need inventory. The customer sees your product for better or worse.

The culture between a product and service business is dramatically different. One sells boxes and the other the "experience" Google is great at experience, and the box business is really tough, it is competitive and one really wonders of Google made the right choice.

The patents were worth the price, the operations of the company may very well not be worth anything, in fact as we see this week they may be costly.

The challenges of making money in a mobile world were not the only
reason that Google’s net revenue and earnings per share fell
significantly below analysts’ expectations. Motorola Mobility, the
ailing cellphone maker it recently acquired, is bleeding money.

This was not a surprise for me, the surprise is that it did not happen sooner.

As the Times continued:

Google executives took pains Thursday in the conference call with
analysts to reassure investors that it was prepared for the challenges
from mobile, and that it was already shifting its business models to
adjust.

“Monetization on mobile queries right now is a significant fraction of
desktop,” Larry Page, Google’s chief executive, said.

He said Google was exploring new ways to make more money as people
increasingly used phones and tablets in addition to and instead of
desktop computers, and said it was “uniquely positioned to get through
that transition and to profit from it.”

“I am not worried about this in terms of our business at all,” Mr. Page said. “I think it’s an opportunity for us.”

The problem is that you do not have to own the farm to get the milk. One should focus on what one does well, and do it again and again, always improving it. Going astray always gets you in trouble.

Further the release of the quarterly filing the way they did should result in significant staff changes in the Finance Department, specifically extreme measures and replacements with those who understand the consequences. Too many free lunches make people sloppy.

The Hill has a piece on the UN sending monitors to US Polls this November. They state:

United Nations-affiliated election monitors from Europe and central Asia
will be at polling places around the U.S. looking for voter suppression
activities by conservative groups, a concern raised by civil rights
groups during a meeting this week. The intervention has drawn criticism
from a prominent conservative-leaning group combating election fraud.

From central Asia, the Taliban from Afghanistan? You really cannot make this up? One wonders whence this arose. This is either the silly season or this is one of the most blatant violations of US sovereignty ever.

In short, I do not believe in free will. I think that everything that a person does is caused by something. It is true, and is the basis of belief in free will, that often we are conscious of considering pros and cons in deciding on a course of action; “we” are deciding, rather than having the decision made by something outside “us.” But calculation and decisionmaking are different. Deciding may just mean calculating the balance of utility and disutility; the result of the balance determines the decision. No doubt when a cat pounces on a mouse, it has decided to do so; but the decision was compelled by circumstances—the feline diet, the presence of the mouse, etc. A complete description of the incident would not require positing free will.

Namely he sides with Luck versus Hard Work. I more than humbly disagree. I often tell folks that to be successful you must be on the corner when the bus goes by, and you must get on the right one. The bus does not come to your house, you must walk to the corner and be prepared for the ride.

I have seen far too many people who want a job, to be told what to do, and then bemoan their fate when the lose what they may have had.

I recall many of my ventures, taking the full risk of no income, focusing on a new idea, selling the idea to others to form a team, raising more capital, and expanding the business. I have never been a Government employee, unless you count my summers as a NYC Lifeguard or my winter shoveling snow for the NYC Sanitation Department. Learning experiences but not jobs.

Posner does not understand that one must do a great deal to be prepared for luck. Many people turn luck down, they really do. They are offered opportunities, which require risks, and they say no. Many would never have the luck because they were not educated enough to realize it when it comes.

As for free will, I totally disagree with Posner, we all too often chose, for better or worse. The "path not taken" was a choice. We are not compelled. There are many who have not become alcoholics, who have not smoked cigarettes, who have lost weight and kept it off, who have not consumed various illegal substances. That was by choice. In fact the very presence, the existence, of those who avoid obesity is proof of choice. If once obese and then no longer, that is a choice, that is a sine qua non example of free will.

I have commented on the MIT 6.002X course and now I will get
a chance to comment on a Harvard one, PH207X, the statistics course from the
Harvard School of Public Health.

Now as before some bona fides. I have taught probability and
statistics in graduate level course at MIT from 1969 through 1975 and at GW University
from 1976 thru 1980. That is as I measure it some 11 years. Then I wrote my
first book in 1969 and published in 1974 on Stochastic Systems and State
Estimation (Wiley). I also published some fifty plus papers in this area as
well. Thus I may have a leg up. I also took a Board Review course at HMS back
in 1994 I believe which used the book by the instructor, good book, early
undergrad level, somewhat cook bookish but does the task. Thus like 6.002X I
come with some experience in the area.

I was again disappointed, left after the middle of the first
problem set. Now why? Simple, the student had to download a cumbersome
statistics package, figure out how to use it from some video by some person who
was using Valley Speak, and waving hands all about the place, and I never could
find the data set. This is another example of never getting to the material,
being encumbered by some generally useless piece of interference.

It is akin to the First Year Latin Instructor at some
expensive private school demanding that homework have been written with a blue
ball point, with names on the top right on each page in green ball point and
dates on the top right in red ball point and a staple ¾” from the top and ¾”
from the left, and parallel with the top of the paper. How about the Latin?
Form and not function. I saw the same problems in 6.002X but not to this extreme.

Why must a student waste so much time on acquiring and
learning some generally useless software package? It would have been much
better to have the student lean the theory and then using Excel for example
work through the analysis in detail.

In my experience for example performing an analysis of
variance process one learns a great deal by actually doing every step in the
analysis and not by using some software package that spits out the answer. Raw
data is what we deal with and the student should and must become familiar with
that data, must work with is, must live with it.

For example, dealing with outliers is a key issue. I wrote
an oft quoted paper on this back in 1975 I believe. What is an outlier and when
do we disregard it and when is the data in an outlier the most important data
element? You learn that only by dealing with all the data.

The instructor does teach a good course and his insights are
quite useful. He provides the novice with a window to statistics as used in the
Medical field. However he does not take the user to the extreme, nor is that
expected in such an introductory course. Thus getting bogged down in the first
step by some third party piece of software is really a waste of time.

It again begs the question of what is the whole purpose of
this venture. Will someone learn, perhaps, but would I ever teach this way,
never. I want the student to understand the principles and to work with the
data, to make the mistakes and to recover from them. I want to the student to
even go as far as saying that the wrong question was asked and the data may be
correct and properly analyzed but you asked the wrong question.

For example
take the NEJM studies on prostate cancer and PSA. They asked if performing PSA
measurements in some manner and using a threshold of 4.0 as a marker for say a
biopsy, did that result in the saving of lives. They concluded that it did not.

But the right question should have been and what procedure and
what data would result in a material change in mortality and morbidity? Perhaps
the answer was 2.0 and not 4.0 and perhaps the answer also required velocity
and percent free PSA as well as normalization on prostate volume. Namely what
was the right question and how do we develop tests to get answers to the right
question.

I come back again to what is the purpose of this course? To
learn how to use a software package or to learn how to employ statistical
analyses in the field of medical trials. I suspect it should have been the
latter.

About Me

Terry has spent most of his career in industry, half in corporate executive positions, and half involved in his start ups. He started on the Faculty and Staff at MIT in 1967 and was there until 1975, and he had returned to MIT from 2005 to 2012 to assist groups of doctoral and post doc students. Terry has focused on a broad set of industries from cable, to satellite, wireless, and even health care software and medical imaging. Terry has published extensively in a broad set of areas as well as having written several books. Terry's view is that of an entrepreneur who has built companies in over twenty countries.
Copyright 2008-2015 Terrence P McGarty all rights reserved.
NOTE: This blog contains personal opinions of the author and is not meant in any manner to provide professional advice, medical advice, financial advice. Reliance on any of the opinions contained herein is done at the risk of the user.

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